Indian Society of Anaesthesiology

Nagpur City Branch

Dear colleagues,

It gives us immense pleasure to launch second issue of e Sense, the news letter of Indian Society of Anaesthesiologists-Nagpur City Branch. We have started this venture with an idea to have interaction with colleagues from different branches of clinical medicine.

In this issue, experts from their respective fields deal with a sensitive issue of “Reactive Airway” .We will be happy to have feedbacks and experiences shared on this subject.

We have heard and often talked about pink puffers and blue bloaters which are the characteristic presentation of patients of COPD . Chronic obstructive pulmonary disease (COPD) represents an important and increasing burden throughout the world. Classically, COPD has been considered a respiratory condition only, mainly caused by tobacco smoking. However now it is known and established that COPD has important manifestations beyond the lungs, the so-called systemic effects. Low-grade, chronic systemic inflammation is one of the key mechanisms underlying these systemic effects. Because these extra-pulmonary manifestations of COPD are common and/or may have significant implications for the patient wellbeing and prognosis, they also warrant systematic screening and appropriate management in order to provide optimal medical care.

Reactive Airways Disease is a general term for conditions involving wheezing and allergic reactions.(1)

Reactive Airways Dysfunction Syndrome (RADS ) :

RADS is a term proposed by Stuart M Brooks and colleagues in 1985(2) to describe an asthma like syndrome developing after a single exposure to high levels of an irritating vapor , fume or smoke.(3) It involves coughing , wheezing and dysnea.(4)

REACTIVE AIRWAY DISEASE: CAN I USE THE TERM?

- DR. Nilofer Salim Mujawar
Professor, Dept. of Paediatrics
NKPSIMS

CV:-

Approved guide for Post Graduate Teaching- Nagpur University / MUHS Recognized
Undergraduate teacher MUHS.
Recognized postgraduate teacher MUHS
Presented papers in national and international conferences and won Best paper award on numerous occasion.
Has been invited as guest faculty.
Regularly conducts Basic Life Support workshop for general public.
Is an active member of IAP,ISCCM and IMA.

Article:-

Frequently one finds the diagnosis written on discharge cards as “reactive airways” and “reactive airways disease”. Perhaps what the physician wanted to convey is a diagnosis of asthma. The terms though highly nonspecific are increasingly used more so by pediatricians. Diagnosing asthma in early childhood is difficult and the tests for asthma especially the lung function tests are not accurate before the age of six years. Thus in such situations describing the clinical condition as reactive airway disease has become a common practice.

ANESTHESIA AND REACTIVE AIRWAY

Anesthetizing patients with “reactive airway” remains a challenge to the anesthesiologist. There is always a possibility of catastrophic bronchospasm and other respiratory complications associated with anesthesia in patients with reactive airways. Anesthesiologist has to be selective regarding the choice of anesthesia technique and the use of drugs in these patients to avoid the provocation of bronchospasm and other airway related complications and if it occurs should recognize and manage appropriately.

“Reactive airways” and “reactive airways disease” are highly nonspecific terms. Patients are usually labeled with “reactive airways” if they have a history of cough, sputum production, wheeze, or dyspnea. The term “reactive airway disease” has been used differently. In one instance reactive airway disease was used as a summary term to describe patients with asthma and/or COPD; in the other it was used synonymously with airway hyperreactivity (1,2)